Stomach Disorders: Vitamin B12 Deficiency and TPN/PPN

Question 1

Folic acid is also which vitamin?

Answer 1

• B9

Question 2

Vitamin B9 and B12 are absorbed by the body due to what substance produced by the stomach?

Answer 2

• Intrinsic factor

Question 3

Folic acid and VitB12 are important to…

Answer 3

• Erythropoiesis

Question 4

A lack of B12 and folic acid causes the body to produce…

Answer 4

• Abnormally large red blood cells that cannot function properly (megaloblastic anemia)

Question 5

Why does Vitamin B12 Deficiency make one weak, tired, lightheaded, SOB, or have pale skin?

Answer 5

• Lack of erythropoiesis leads to anemia and lack of oxygenation

Question 6

What are the s/s of Vitamin B12 Deficiency?

Answer 6

• Weakness, tiredness, lightheadedness
• Heart palpitations and SOB
• Pale skin
• Beefy tongue
• Constipation, Diarrhea loss of appetite or gas
• Vision loss

Question 7

What other vitamins and minerals are affected by lack of intrinsic factor besides vitamin B12

Answer 7

• Iron
• Calcium
• Folic acid

Question 8

What foods contain vitamin B12?

Answer 8

• meat
• fish
• milk
• cheese
• eggs

Question 9

What is the tx for Vitamin B12 Deficiency as a result of gastric surgery?

Answer 9

• Will need to be given via injection at first
• When sufficient, supplements will be needed

Question 10

What is enteral feeding?

Answer 10

• Enteral administration is food or drug administration via the human gastrointestinal tract.

Question 11

What is parenteral feeding?

Answer 11

• Nutrition or drug administration that occurs from routes outside the GI tract, such as intravenous routes

Question 12

What is TPN?

Answer 12

• Total Parenteral Nutrition
• It is a method of getting nutrition into the body through the veins for patients who do not have a functioning GI tract or who have disorders requiring complete bowel rest

Question 13

TPN is a long-term therapy for nutrition. What is the number 1 issue to continually assess for?

Answer 13

• Infection

Question 14

What is PPN?

Answer 14

• Partial Parenteral Nutrition (aka Peripheral Parenteral Nutrition)
• Method used for clients that can take some oral nutrition, but not enough to meet the body’s needs

Question 15

Through what route is TPN administered?

Answer 15

• Via PICC line in
• Subclavian vein or
• Jugular vein

Question 16

Through what route is PPN administered?

Answer 16

• A peripheral IV port

Question 17

What are the risks of inserting a PICC line?

Answer 17

• Veinous puncture through
• Lung puncture → pneumothorax

Question 18

Why does is a central line needed for TPN?

Answer 18

• The vein is large enough to handle the nutrition mixture

Question 19

What is the risk of administering a TPN mixture through a peripheral IV?

Answer 19

• Vascular collapse due to the viscosity (high osmolality) of TPN solution

Question 20

What type of needle is used for TPN?

Answer 20

• ≥ 16 gauge

Question 21

What is the insertion procedure for a PICC line?

Answer 21

• Pt = supine
• Have pt take a deep breath and then hold
• On hold, insert needle
  
  • This is so the chest is still and reduces risk of pneumothorax
• Assess vitals for signs of infiltration or pneumothroax
• Confirm placement by x-ray

Question 22

How is a TPN solution obtained and started?

Answer 22

• Doc confirms placement and gives TPN prescription
• Prescription is mixed per pt and can take around 6hrs to be delivered
• Get baseline vitals and weight
• Start feeding
• Document/Chart everything

Question 23

How often is the TPN solution updated by the HCP?

Answer 23

• Daily

Question 24

How are we monitoring glucose/electrolyte levels during TPN?

Answer 24

• Daily blood labs
• Finger sticks ever 4hrs

Question 25

Why might a pt become hyper/hypoglycemic on TPN?

Answer 25

• Glucose levels provided are too high/low

Question 26

What are we checking during TPN to monitor fluid balance?

Answer 26

* Check sodium and potassium levels * Blood pressure * Weight

Question 27

What are normal potassium levels?

Answer 27

• 3.5 - 5.0

Question 28

How can TPN affect the biliary system?

Answer 28

* Over time, the TPN solution can cause bile to become more viscous or “sludge” * This can lead to cholelithiasis (gallbladder stones)

Question 29

How can TPN affect the hepatic system?

Answer 29

• Over time, the pt can develop steatosis (fatty liver)

Question 30

What clinical sign will indicate liver disease?

Answer 30

* Elevated LFT (Liver Function Tests) * ALP, AST, ALT, GTT

Question 31

What is the TPN concentration?

Answer 31

* Aminoacid: 4.25% * Dextrose: 25-50% * Fat: \>20%

Question 32

What is the PPN concentration?

Answer 32

* Aminoacid: 1.75-305% * Dextrose: 5-10% * Fat: ≤ 20%

Question 33

Which is the used more commonly, PPN or TPN?

Answer 33

• TPN

Question 34

What type of PICC line is used for TPN?

Answer 34

• Triple lumen

Question 35

Why is a triple lumen PICC line used for TPN and what is its benefit to the pt?

Answer 35

* It allows for constant TPN administration through one lumen * Can administer fluids or abx through another * Can take blood samples from another * Benefit to pt: less sticks

Question 36

True or False It is permissible to do a blood transfusion or administer blood products through the TPN PICC line.

Answer 36

* False, it will cause a coagulation issue * A peripheral IV line must be used

Question 37

TPN is indicated for patient conditions?

Answer 37

* GI tract cannot tolerate/process enteral feeding * Post surgery and the bowel needs to rest for healing

Question 38

Should patients with AIDS, cancer, malnutrition or clients receiving chemotherapy have TPN or PPN?

Answer 38

• Pending their GI tolerance/status, could be either

Question 39

True or False The TPN rate may be sped up or slowed down.

Answer 39

• False, TPN rate must remain constant

Question 40

Why must the TPN rate remain constant?

Answer 40

• Varying the speed can cause coagulation issues putting the pt at risk for embolism

Question 41

What do we do with the TPN feeding @ end of shift?

Answer 41

• Document unused and replace?

Question 42

When must a dressing change be done for the PICC line?

Answer 42

• Unless otherwise indicated, weekly, using sterile technique

Question 43

What are the complications of parenteral nutrition?

Answer 43

* Hyper/Hypoglycemia * Electrolyte imbalance * Fluid imbalance * Biliary disease (cholelithiasis and sludge) * Hepatic disease (steatosis, elevated LFT) * Refeeding syndrome

Question 44

What is a normal glucose levels?

Answer 44

• Between 70-140

Question 45

What are low glucose levels?

Answer 45

* \< 70 is low * \<55 requires immediate action

Question 46

What are normal sodium levels?

Answer 46

• 135-145